Dementia and BPSD

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the formal term for dementia as defined by the DSM-5?

Neuropsychiatric Disturbance Syndrome (NDS)
Major Neurocognitive Disorder (MND) (correct)
Geriatric Cognitive Impairment (GCI)
Behavioral and Psychological Symptoms of Dementia (BPSD)

Which of the following is NOT a typical etiology that leads to dementia?

Vascular dementia
Multiple sclerosis (correct)
Lewy body dementia
Alzheimer's disease

Behavioral and psychological symptoms of dementia (BPSD) primarily affect which two areas of a patient's life?

Nutritional intake and sleep patterns
Cardiovascular health and respiratory function
Cognitive function and motor skills
Functional abilities and quality of life (correct)

Which of the following best describes the nature of BPSD symptoms in relation to psychiatric disorders?

BPSD includes emotional, perceptual, and behavioral disturbances that are similar to those seen in psychiatric disorders (D) Signup and view all the answers

A patient with dementia exhibits sudden, intense fear and believes their caregiver is trying to harm them. Which BPSD symptom is most likely being displayed?

Delusion (C) Signup and view all the answers

Apathy is a common BPSD symptom. Which of the following behaviors would MOST clearly indicate apathy in a dementia patient?

Loss of interest in previously enjoyed hobbies or activities (B) Signup and view all the answers

A clinician is developing a management plan for a dementia patient exhibiting BPSD. What is the MOST critical initial step?

Conducting a comprehensive assessment of potential contributing factors. (C) Signup and view all the answers

An interprofessional team is caring for a patient with dementia and severe agitation. Despite non-pharmacological interventions, the patient's agitation escalates, posing a safety risk. Which factor should the team prioritize when deciding whether to initiate pharmacological treatment for BPSD?

A clearly defined target symptom with measurable outcomes, alongside potential risks/benefits. (B) Signup and view all the answers

Which class of medications, when withdrawn, is least likely to contribute to Behavioral and Psychological Symptoms of Dementia (BPSD)?

Antihistamines (A) Signup and view all the answers

Akathisia, a potential cause of Behavioral and Psychological Symptoms of Dementia (BPSD), can arise from the use of which type of medication?

Second-generation antipsychotics (A) Signup and view all the answers

What percentage range of dementia patients are estimated to experience pain, which is associated with increased Behavioral and Psychological Symptoms of Dementia (BPSD)?

46% to 56% (A) Signup and view all the answers

Which of the following is NOT a recommended approach for assessing comfort in patients with dementia?

Direct questioning without caregiver input (B) Signup and view all the answers

Which of the following tools is specifically designed and validated for objectively evaluating and tracking pain in advanced dementia?

Pain Assessment in Advanced Dementia (PAINAD) scale (D) Signup and view all the answers

Why is establishing a clear baseline critically important when assessing Behavioral and Psychological Symptoms of Dementia (BPSD)?

To have a reference point for assessing treatment effects, given the fluctuating and subjective nature of Behavioral and Psychological Symptoms of Dementia (BPSD). (A) Signup and view all the answers

Which domain is NOT evaluated by the Neuropsychiatric Inventory (NPI) for assessing overall Behavioral and Psychological Symptoms of Dementia (BPSD)?

Cognitive impairment (C) Signup and view all the answers

A patient with dementia exhibits increased agitation and aggression. Initial assessment reveals the patient is on a stable dose of a second-generation antipsychotic. Despite the stable dose, symptoms worsen. Considering the information provided, what is the MOST critical next step?

Assess for akathisia as a potential side effect of the antipsychotic (C) Signup and view all the answers

Which of the following non-pharmacological interventions has demonstrated anecdotal effectiveness in managing agitation?

Providing busy quilts. (A) Signup and view all the answers

What is a significant limitation associated with the use of psychotropic medications in treating BPSD?

They have a high side effect burden and modest benefits. (B) Signup and view all the answers

What percentage range of dementia patients receive analgesics for painful conditions, compared to those without dementia?

20% to 40%, compared to 60% to 80% of similar patients without dementia. (A) Signup and view all the answers

In the context of BPSD treatment, why is the empiric treatment of pain considered a crucial first step?

Because untreated pain has a strong relationship with BPSD. (C) Signup and view all the answers

What was the primary outcome measure used in the multicenter cluster randomized controlled trial that examined the effect of a stepwise protocol for empiric treatment of pain in patients with dementia-related agitation?

Changes in scores on the Cohen-Mansfield Agitation Inventory. (C) Signup and view all the answers

In the 8-week multicenter study on empiric pain treatment for BPSD, what was the magnitude of agitation reduction in the intervention group, and how does this compare to the effect seen with risperidone?

17% reduction, an effect comparable to that seen with risperidone. (D) Signup and view all the answers

A clinician is deciding on a treatment plan for a patient with BPSD who exhibits wandering and repetitive vocalizations. Based on current evidence, which approach is MOST appropriate?

Prioritize non-pharmacological measures, as these symptoms rarely respond to pharmacotherapy. (B) Signup and view all the answers

An elderly patient with dementia is prescribed pregabalin as part of a stepwise protocol for empiric pain management. Which of the following dosages of pregabalin would be LEAST appropriate, considering the study's findings and typical geriatric considerations for medication management?

300 mg daily, as this dosage was used in the original study. (A) Signup and view all the answers

What is the recommended first-line pharmacotherapy for agitated behaviors in patients without Lewy body dementia or Parkinson's disease, after non-pharmacological interventions have been tried?

Citalopram or Sertraline (C) Signup and view all the answers

In patients with Lewy body dementia or Parkinson's disease experiencing agitation, what is the recommended next step if Citalopram or Sertraline are ineffective?

Adding an acetylcholinesterase inhibitor (if not already prescribed) (C) Signup and view all the answers

How often should trials of antipsychotic tapering be attempted?

Every 3 to 6 months (A) Signup and view all the answers

Why should Olanzapine generally be avoided when cross-titrating antipsychotics?

Due to its anticholinergic effects and lower benefit overall (A) Signup and view all the answers

For depression in patients with dementia, what medication is suggested to be added if there is a limited response after an adequate trial of Citalopram or Sertraline?

Methylphenidate (D) Signup and view all the answers

Which neurostimulation therapy has shown benefit in most studies for treatment-refractory patients with dementia?

Repetitive transcranial magnetic stimulation (D) Signup and view all the answers

A patient with Parkinson's disease exhibits agitation. They are already prescribed an acetylcholinesterase inhibitor. Which of the following would be the MOST appropriate next step according to the guidelines?

Trial Pimavanserin or Quetiapine (D) Signup and view all the answers

A patient with severe agitation and aggressive symptoms requires immediate initiation of antipsychotic therapy. Which crucial step should NOT be overlooked despite the initiation of pharmacotherapy?

Implementing additional interventions and attempting discontinuation when the patient stabilizes (C) Signup and view all the answers

Which of the following best describes the focus of the Cohen-Mansfield Agitation Inventory (CMAI)?

Specifically evaluating agitated behaviors, categorized as physical, verbal, aggressive, or non-aggressive. (D) Signup and view all the answers

What is the initial step recommended for managing Behavioral and Psychological Symptoms of Dementia (BPSD), assuming the patient does not pose an immediate danger to themselves or others?

Establishing a baseline by identifying and quantifying target symptoms. (D) Signup and view all the answers

For assessing Behavioral and Psychological Symptoms of Dementia (BPSD), what is considered the most accurate method to gather information from caregivers regarding a patient's symptoms?

Having caregivers maintain a daily prospective diary or calendar. (D) Signup and view all the answers

A patient with dementia is exhibiting aggression and poses a risk of injury to caregivers. Pharmacological interventions have been attempted but have been unsuccessful. Which of the following is the MOST appropriate setting for managing this patient?

Referral to a geropsychiatry unit. (C) Signup and view all the answers

Which of the following scenarios necessitates managing a patient with BPSD in a hospital setting?

The patient requires parenteral medications due to delirium. (A) Signup and view all the answers

A caregiver reports that a patient with dementia frequently resists assistance during dressing, exhibiting distress about 60% of the time, which causes the caregiver significant upset (rated 8 out of 10 on a distress scale). According to the provided information, what is the next recommended step in managing this BPSD?

Implement non-pharmacological interventions and continue to monitor and document instances of resistance and distress. (A) Signup and view all the answers

What is the PRIMARY reason systematic trials of evidence-based pharmacological therapies are considered in the management of BPSD?

To address target symptoms when non-pharmacological interventions are insufficient, and after establishing a baseline. (A) Signup and view all the answers

A researcher aims to comprehensively evaluate the effectiveness of a novel intervention for managing agitation in patients with Alzheimer's disease. Considering the potential differences captured by various assessment tools, which combination of assessments would offer the MOST thorough and nuanced understanding of the intervention's impact on agitation and related BPSD?

Combining the NPI, BEHAVE-AD, and CMAI to capture a broad spectrum of BPSD symptoms in addition to agitation. (D) Signup and view all the answers

Which of the following antipsychotics is generally LEAST preferred in Lewy body dementia and dementia associated with Parkinson's disease due to the risk of worsening motor symptoms?

Risperidone (C) Signup and view all the answers

What special consideration is required when prescribing clozapine?

Special monitoring and reporting is required. (A) Signup and view all the answers

What is the established starting and target dosage of pimavanserin for psychosis related to Parkinson's disease?

Fixed dosage of 34mg for both starting and target. (A) Signup and view all the answers

Patients on antipsychotics should be monitored for adverse motor effects and medication tapering should be attempted how often?

Every 3 to 6 months (A) Signup and view all the answers

According to cited research, what is the approximate percentage of patients on long-term antipsychotics who can be successfully discontinued without a worsening of BPSD?

80% (A) Signup and view all the answers

Which of the following SSRIs has demonstrated effectiveness in improving agitation and aggression in patients, according to a 2011 meta-analysis:

Sertraline (D) Signup and view all the answers

In a study of Citalopram at 30 mg daily versus placebo, what average increase in corrected QT interval was observed in patients?

18 ms (D) Signup and view all the answers

When initiating SSRIs for mild to moderate BPSD in elderly patients, what critical principle from geropsychiatry should guide the dosing strategy?

"Start low, go slow, but go as high as you need to go" (C) Signup and view all the answers

Flashcards

Major Neurocognitive Disorder (MND)

A formal term for dementia, defined by the DSM-5, involving cognitive decline and loss of function.

Behavioral and Psychological Symptoms of Dementia (BPSD)

Neuropsychiatric symptoms like delusions, apathy, anxiety, or disinhibition that accompany dementia.